Victims of a culture that puts their needs last, more women die from childbirth in India than anywhere else in the world.

Sugia Devi, who is nine months pregnant, adjusts her sari outside of her home in the village of Mounia in the state of Bihar, India, December 8, 2011. [Allison Shelley]

The operating room was chilly on a grey morning in Bihar, Northern India. Tile floors did nothing to insulate from the thick, damp cold seeping through the blankets on rickety hospital beds.

Sugia Devi was spread on the operating table like a martyr, arms wide. But Devi wasn't dead; she was active and flailing in pain. Throughout her caesarean section she responded to each incision, each stitch, jerking her face away and moaning ghoulishly.

India's other sexual violence is the failure to care for pregnant women, medically and socially.

The doctors working on her abdomen, distracted by pulling out the baby and answering a phone call, ignored her cries. But the junior doctor standing next to her face, heard. He held down the thin gauze strip covering her eyes, pressing so strongly he indented the mounds of her cheeks. The cover was ineffective; beneath the thin cloth her eyes were visible, darting in fear.

The doctor pumped Devi full of pain medications during the surgery, and he said that after that she was moaning out of fear. Devi, however, blatantly disagreed: "I remember that I was shouting out of pain."

When she moaned Kumar shook her, then jerked her, and finally hit her, over and over during the surgery. His lip snarled and he looked angry at the disturbance. There was no concept of her cries representing a physical need or something wrong with her pain control. They were only annoying. Devi, abdomen still open, half anesthetized, uterus exposed, had no choice but to weather the health worker's blows.

Devi's physical abuse during her delivery is just one case of the violence many Indian women suffer during their reproductive lives. In the aftermath of the high-profile gang rape of a 23-year-old medical student, discussions have raged in India about the regularity of violence against women. As has been widely noted, the causes of the violence run deep. But they also are broad.

India's other sexual violence is the failure to care for pregnant women, medically and socially. The ingrained iniquities and widespread disregard for women's needs during pregnancy and childbirth contribute to India's shockingly high maternal death rates.

Bihar, where Devi's C-section took place, has among the highest rates of maternal deaths in the country. And India overall is home to the highest number of women dying from childbirth in the world. The majority of Indian women who die in childbirth are poor, uneducated, and young.

Women die around delivery mostly due to excessive bleeding, obstructed labor, infection, and issues around high blood pressure, including eclampsia. But these are the medical causes.

Please use a JavaScript-enabled device to view this slideshow

Women die in their homes under the watch of poorly trained midwives and village doctors. Women die in rickshaws when families make last minute runs to the health center. And many of these women die without ever having any say in decisions about their health.

Kumar's abusive behavior in the operating room directly contradicted the World Health Organization guidelines for cesarean section: "The use of local anaesthesia for caesarean section requires that the provider counsel the woman and reassure her throughout the procedure. The provider must keep in mind that the woman is awake and alert, and should use instruments and handle tissue as gently as possible."

Abuse of laboring women, while not well-tallied, is a global issue. A 2002 article in the Lancet called such abuse "a means of controlling patients" and a USAID survey cited violence at the hands of health providers as an "important barrier" to women wanting to birth in clinics.

Devi was terrified of going to the hospital, and had planned to birth at home. But when the labor failed to progress, despite hours of massaging by midwives and prayers by local priests, the family took her to a local pharmacy owned by an informally trained "village doctor."

When the informal health sector proved incompetent, and after over 24 hours in labor, the family argued over finances before finally agreeing to take Devi to the private medical clinic for the operation. The delivery cost 9,000 rupees ($167) a debilitating amount for her impoverished, low-caste family, in a state with a $360 average yearly income.

Part of Devi's problem was that she was anemic. With her low hemoglobin levels, she didn't have the physical strength to carry her through her long labor. In the months before her doctor had warned her about anemia, a common complication in India. But despite the doctor's suggestions, she ate her usual high carbohydrate diet, mostly rice and the typical flat bread, chapatti: "The food we generally eat...what else?"

Devi could not conceive of heeding her doctor's advice or choosing to increase her nutritional intake. In Bihar, less than a third of women participate in household decisions, so like her lack of say in where she would deliver, Devi probably had little influence over what she was eating.

Recommended

In most families women eat after men, and daughters-in-law eat last among the women. This ingrained social norm means men eat more nutritious meals everyday, which weakens women throughout their lives and makes them more susceptible to diseases. Thirty-two percent of men in Bihar are anemic, compared to 68 percent of women. During pregnancy, malnutrition contributes to life-threatening complications.

Any time we visited Devi in the village she was patting cow dung to dry for fuel or taking long walks with the family's buffalo in the field. She continued to work until she went in to labor. Even though she had had a false start to her labor nearly a month before her delivery, she was given no time to rest between all of her household responsibilities.

While Devi was illiterate and did not know her age, in her village most women were married as young teenagers. Girls under 15 are five times more likely to die in childbirth than women in their twenties, but child brides are immediately expected to start producing children. Devi's midwife, Malti explained, "Until a woman becomes a mother, she is not valued at home." So young girls married as teenagers are immediately pressured to conceive, putting them at higher risk of obstructed labor or fistula, complications arising from the baby's head being too large to fit through the pelvis or birth canal.

In the end, Devi's baby was breach, so the caesarean section was unavoidable. But at every step in the process Devi embodied India's ongoing attacks on women, be they decisions to feed them last, marry them as teenagers, skimp on their medical care, or gang rape them on a bus. With violence permeating their sexual lives, from conception to delivery, the deadly rape cases are only the most publicized examples of a quieter epidemic.

This reporting was made possible with a joint grant from the White House News Photographers Association and PNY Technologies.

About the Authors

Allyn Gaestel is a freelance journalist based in Port-au-Prince, Haiti, who writes on international politics, social issues, and human rights. She is a former United Nations correspondent and National Press Foundation Fellow.

Most Popular

Should you drink more coffee? Should you take melatonin? Can you train yourself to need less sleep? A physician’s guide to sleep in a stressful age.

During residency, Iworked hospital shifts that could last 36 hours, without sleep, often without breaks of more than a few minutes. Even writing this now, it sounds to me like I’m bragging or laying claim to some fortitude of character. I can’t think of another type of self-injury that might be similarly lauded, except maybe binge drinking. Technically the shifts were 30 hours, the mandatory limit imposed by the Accreditation Council for Graduate Medical Education, but we stayed longer because people kept getting sick. Being a doctor is supposed to be about putting other people’s needs before your own. Our job was to power through.

The shifts usually felt shorter than they were, because they were so hectic. There was always a new patient in the emergency room who needed to be admitted, or a staff member on the eighth floor (which was full of late-stage terminally ill people) who needed me to fill out a death certificate. Sleep deprivation manifested as bouts of anger and despair mixed in with some euphoria, along with other sensations I’ve not had before or since. I remember once sitting with the family of a patient in critical condition, discussing an advance directive—the terms defining what the patient would want done were his heart to stop, which seemed likely to happen at any minute. Would he want to have chest compressions, electrical shocks, a breathing tube? In the middle of this, I had to look straight down at the chart in my lap, because I was laughing. This was the least funny scenario possible. I was experiencing a physical reaction unrelated to anything I knew to be happening in my mind. There is a type of seizure, called a gelastic seizure, during which the seizing person appears to be laughing—but I don’t think that was it. I think it was plain old delirium. It was mortifying, though no one seemed to notice.

Why the ingrained expectation that women should desire to become parents is unhealthy

In 2008, Nebraska decriminalized child abandonment. The move was part of a "safe haven" law designed to address increased rates of infanticide in the state. Like other safe-haven laws, parents in Nebraska who felt unprepared to care for their babies could drop them off in a designated location without fear of arrest and prosecution. But legislators made a major logistical error: They failed to implement an age limitation for dropped-off children.

Within just weeks of the law passing, parents started dropping off their kids. But here's the rub: None of them were infants. A couple of months in, 36 children had been left in state hospitals and police stations. Twenty-two of the children were over 13 years old. A 51-year-old grandmother dropped off a 12-year-old boy. One father dropped off his entire family -- nine children from ages one to 17. Others drove from neighboring states to drop off their children once they heard that they could abandon them without repercussion.

His paranoid style paved the road for Trumpism. Now he fears what’s been unleashed.

Glenn Beck looks like the dad in a Disney movie. He’s earnest, geeky, pink, and slightly bulbous. His idea of salty language is bullcrap.

The atmosphere at Beck’s Mercury Studios, outside Dallas, is similarly soothing, provided you ignore the references to genocide and civilizational collapse. In October, when most commentators considered a Donald Trump presidency a remote possibility, I followed audience members onto the set of The Glenn Beck Program, which airs on Beck’s website, theblaze.com. On the way, we passed through a life-size replica of the Oval Office as it might look if inhabited by a President Beck, complete with a portrait of Ronald Reagan and a large Norman Rockwell print of a Boy Scout.

Since the end of World War II, the most crucial underpinning of freedom in the world has been the vigor of the advanced liberal democracies and the alliances that bound them together. Through the Cold War, the key multilateral anchors were NATO, the expanding European Union, and the U.S.-Japan security alliance. With the end of the Cold War and the expansion of NATO and the EU to virtually all of Central and Eastern Europe, liberal democracy seemed ascendant and secure as never before in history.

Under the shrewd and relentless assault of a resurgent Russian authoritarian state, all of this has come under strain with a speed and scope that few in the West have fully comprehended, and that puts the future of liberal democracy in the world squarely where Vladimir Putin wants it: in doubt and on the defensive.

The same part of the brain that allows us to step into the shoes of others also helps us restrain ourselves.

You’ve likely seen the video before: a stream of kids, confronted with a single, alluring marshmallow. If they can resist eating it for 15 minutes, they’ll get two. Some do. Others cave almost immediately.

This “Marshmallow Test,” first conducted in the 1960s, perfectly illustrates the ongoing war between impulsivity and self-control. The kids have to tamp down their immediate desires and focus on long-term goals—an ability that correlates with their later health, wealth, and academic success, and that is supposedly controlled by the front part of the brain. But a new study by Alexander Soutschek at the University of Zurich suggests that self-control is also influenced by another brain region—and one that casts this ability in a different light.

Modern slot machines develop an unbreakable hold on many players—some of whom wind up losing their jobs, their families, and even, as in the case of Scott Stevens, their lives.

On the morning of Monday, August 13, 2012, Scott Stevens loaded a brown hunting bag into his Jeep Grand Cherokee, then went to the master bedroom, where he hugged Stacy, his wife of 23 years. “I love you,” he told her.

Stacy thought that her husband was off to a job interview followed by an appointment with his therapist. Instead, he drove the 22 miles from their home in Steubenville, Ohio, to the Mountaineer Casino, just outside New Cumberland, West Virginia. He used the casino ATM to check his bank-account balance: $13,400. He walked across the casino floor to his favorite slot machine in the high-limit area: Triple Stars, a three-reel game that cost $10 a spin. Maybe this time it would pay out enough to save him.

“Well, you’re just special. You’re American,” remarked my colleague, smirking from across the coffee table. My other Finnish coworkers, from the school in Helsinki where I teach, nodded in agreement. They had just finished critiquing one of my habits, and they could see that I was on the defensive.

I threw my hands up and snapped, “You’re accusing me of being too friendly? Is that really such a bad thing?”

“Well, when I greet a colleague, I keep track,” she retorted, “so I don’t greet them again during the day!” Another chimed in, “That’s the same for me, too!”

Unbelievable, I thought. According to them, I’m too generous with my hellos.

When I told them I would do my best to greet them just once every day, they told me not to change my ways. They said they understood me. But the thing is, now that I’ve viewed myself from their perspective, I’m not sure I want to remain the same. Change isn’t a bad thing. And since moving to Finland two years ago, I’ve kicked a few bad American habits.

A report will be shared with lawmakers before Trump’s inauguration, a top advisor said Friday.

Updated at 2:20 p.m.

President Obama asked intelligence officials to perform a “full review” of election-related hacking this week, and plans will share a report of its findings with lawmakers before he leaves office on January 20, 2017.

Deputy White House Press Secretary Eric Schultz said Friday that the investigation will reach all the way back to 2008, and will examine patterns of “malicious cyber-activity timed to election cycles.” He emphasized that the White House is not questioning the results of the November election.

Asked whether a sweeping investigation could be completed in the time left in Obama’s final term—just six weeks—Schultz replied that intelligence agencies will work quickly, because the preparing the report is “a major priority for the president of the United States.”

A professor of cognitive science argues that the world is nothing like the one we experience through our senses.

As we go about our daily lives, we tend to assume that our perceptions—sights, sounds, textures, tastes—are an accurate portrayal of the real world. Sure, when we stop and think about it—or when we find ourselves fooled by a perceptual illusion—we realize with a jolt that what we perceive is never the world directly, but rather our brain’s best guess at what that world is like, a kind of internal simulation of an external reality. Still, we bank on the fact that our simulation is a reasonably decent one. If it wasn’t, wouldn’t evolution have weeded us out by now? The true reality might be forever beyond our reach, but surely our senses give us at least an inkling of what it’s really like.

We can all agree that Millennials are the worst. But what is a Millennial? A fight between The New York Times and Slate inspired us to try and figure that out.

This article is from the archive of our partner .

We can all agree that Millennials are the worst. But what is a Millennial? A fight between The New York Times and Slate inspired us to try and figure that out.

After the Times ran a column giving employers tips on how to deal with Millennials (for example, they need regular naps) (I didn't read the article; that's from my experience), Slate's Amanda Hess pointed out that the examples the Times used to demonstrate their points weren't actually Millennials. Some of the people quoted in the article were as old as 37, which was considered elderly only 5,000 short years ago.

The age of employees of The Wire, the humble website you are currently reading, varies widely, meaning that we too have in the past wondered where the boundaries for the various generations were drawn. Is a 37-year-old who gets text-message condolences from her friends a Millennial by virtue of her behavior? Or is she some other generation, because she was born super long ago? (Sorry, 37-year-old Rebecca Soffer who is a friend of a friend of mine and who I met once! You're not actually that old!) Since The Wire is committed to Broadening Human Understanding™, I decided to find out where generational boundaries are drawn.